COPD and Risk for Carotid Disease

Can COPD Raise the Risk for Carotid Artery Disease?

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Chronic obstructive pulmonary disease (COPD) can promote disease beyond the lungs, according to the authors of a recent prospective epidemiological study (Lahousse L et al. Chronic Obstructive Pulmonary Disease and Lipid Care Carotid Artery Plaques in the Elderly: The Rotterdam Study. Am J Respir Crit Care Med. November 19, 2012 doi: rccm.2012206-10460c). The authors note that COPD is an independent risk factor for stroke, and that the degree of airway obstruction is positively associated with a higher risk for stroke.

Most strokes begin with the rupture of arterial plaques. Some plaques, such as those with a lipid core, are more vulnerable for rupture. Although COPD might increase atherosclerosis (hardening of the arteries), limited data exist regarding the type of plaque associated with COPD. The current study by Lahousse and colleagues addresses this issue.

According to the authors, new evidence solidifies a link between COPD and the increased presence of risky carotid artery plaque in elderly patients. “Clinicians should be aware that asymptomatic carotid atherosclerosis is more prevalent in subjects with COPD and that COPD as a systemic inflammatory disease might lead to vulnerable plaques by inducing or aggravating the presence of a lipid core.”

Participants with COPD had twice the risk of presenting with a lipid-core plaque compared with control patients with normal lung function, after controlling for multiple factors including age, sex, body mass index, smoking status, diabetes, and hypertension. In addition, the risk increases as the COPD airflow limitation increases. Patients with severe airflow limitation, for example, had a greater than 6-fold increased risk for carotid wall thickening compared with control patients, after adjusting for multiple factors.

This study demonstrated an increased risk of carotid artery plaque formation and of presence of vulnerable plaques with a lipid core in population-based elderly patients with COPD. The precise mechanism behind the association of COPD and the progression of carotid artery plaque remains unknown.